Arthroscopic Knotless Separate Layer Transosseous Equivalent Repair of Delaminated Rotator Cuff Tears

Does biceps tenodesis screw with forked eyelet decrease the risk of Popeye deformity when compared to traditional closed eyelet screws?

Objective: While many biomechanical studies have compared various biotenodesis materials for biceps tenodesis, there is a lack of research comparing different types of interference screws. This study aimed to compare the impact of a polyether ether ketone (PEEK) forked eyelet tenodesis screw with the traditional PEEK closed eyelet whipstitching technique. The focus was on evaluating the occurrence of Popeye deformity, which is an objective predictor of a successful arthroscopic suprapectoral long head of biceps tenodesis. Methods: A retrospective analysis was conducted on patients who underwent arthroscopic rotator cuff repair and biceps tenodesis performed by a single surgeon between January 2010 and 2020 at a single center. The follow-up period was at least 1 year. Exclusion criteria included previous shoulder surgery and osteoarthritis. Patients were divided into 2 groups based on the type of tenodesis anchor used: forked eyelet tenodesis screw versus closed eyelet tenodesis screw. The occurrence of Popeye deformity was compared between the 2 groups. Results: A total of 82 patients who underwent arthroscopic rotator cuff repair and biceps tenodesis were evaluated, with a mean follow-up of 24.5 ± 4 months. The patients operated on using forked eyelet tenodesis screw were labeled as Group I (n=72) and those with traditional PEEK closed eyelet screw as Group II (n=10). There were no significant differences between the groups in terms of age (Group I: 59.4 ± 5, Group II: 58.4 ± 4, P=.896), gender (both groups predominantly male, P=.886), and body mass index (Group I: 26.7 ± 2, Group II: 27 ± 3; P=.896). The overall rate of popeye deformity in all patients was 8% (n=7). No significant difference in popeye deformity occurrence was observed between the 2 groups (Group I: 6/72 (8.3%), Group II: 1/10 (10%); P=.998). Conclusion: The incidence of Popeye deformity after arthroscopic biceps tenodesis in patients undergoing concomitant rotator cuff repair is low. The choice of fixation anchor, whether a forked eyelet or closed eyelet PEEK anchor, does not significantly influence the occurrence of Popeye deformity. Level of Evidence: Level III, Therapeutic study.

Comparison of En Masse Repair versus Separate Double-Layer Repair for Delaminated Rotator Cuff Tears: A Systematic Review and Meta-Analysis

BACKGROUND

Delamination of cuff tendons has a negative impact on outcomes following arthroscopic rotator cuff repair (RCR). The purpose of this study is to compare en masse repair (EMR) and separate double-layer repair (SDLR) for delaminated rotator cuff tears.

METHODS

A systematic literature search was conducted on major databases (MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus) until 1 June 2023. Comparative studies with a minimum 24-month follow-up of patients undergoing arthroscopic RCR for delaminated tears were included. The outcomes assessed retear rates and functional outcomes.

RESULTS

Five eligible studies involving 325 cases were analyzed. The meta-analysis showed no significant difference in retear rates between SDLR and EMR for delaminated tears (OR = 0.73, 95% CI: 0.35-1.49). However, the meta-analysis demonstrated a significant intergroup difference in favor of the SDLR for the total Constant score (SMD = 0.68, 95% CI: 0.35 to 1.02), SST score (SMD = 0.37, 95% CI: 0.02 to 0.71), and postoperative range of abduction (SMD = 0.34, 95% CI: 0.03 to 0.64).

CONCLUSION

The evidence suggests that the SDLR in arthroscopic RCR for delaminated rotator cuff tears leads to improved short-term functional outcomes and range of motion compared to EMR. However, there is no significant difference in retear risk between the two approaches.

Intraosseous calcific tendinitis of the rotator cuff yields similar outcomes to those of intratendinous lesions despite worse preoperative scores

PURPOSE

To evaluate the surgical outcomes of arthroscopic removal of intraosseous deposits in patients with intraosseous calcific tendinitis of the rotator cuff.

METHODS

This study involved a retrospective review of 96 patients operated on from 2004 to 2019. Patients were divided into two groups according to the location of calcific deposits. Group I had pure tendinous involvement (n = 71), and Group II had tendinous and intraosseous involvement (n = 25). The mean follow-up time was 6.4 ± 3.9 years. There were 71 patients (46 women, 25 men) in Group I, and the mean age was 49.3 ± 8.2 years (range 30-65 years). In group II, there were 25 patients (18 women, 7 men); the mean age was 47.3 ± 11.2 years (range 28-70 years).

RESULTS

The mean preoperative VAS pain score was 8.8 ± 1.4 in Group I compared to 9.5 ± 0.5 in group II (p = 0.017). The median preoperative Constant and Oxford scores were 42 (20-65) and 22 (8-34) in Group I and 25.5 (22-46) and 10 (8-16) in group II, respectively (p < 0.001). There was no difference in postoperative pain scores (Group I: 0.7 ± 1.6 and group II: 0.5 ± 0.6, p = 0.926), Constant scores [Group I: 100 (80-100) and group II: 100 (90-100), (n.s).] and Oxford scores [Group I: 48 (28-48) and group II: 46.5 (4-48), (n.s.)] between the two groups. The number of preoperative injections was higher in Group II (p = 0.05). There was no correlation between the size of the soft tissue calcific deposit and the preoperative pain, Constant, and Oxford scores (n.s.).

CONCLUSION

Arthroscopic debridement of calcific tendinitis with intraosseous involvement is a safe and effective treatment method similar to that of pure tendinous involvement.

LEVEL OF EVIDENCE

III.